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09.15.04
Whirlwind gets war victims fund grant for Colombia

Whirlwind has won a grant from the Leahy War Victims Fund (LWVF), a part of the United States Agency for International Development (USAID) for a 20-month project in Colombia, South America. The project will run from November 2004 to July 2006. The project’s goal is to promote the social and economic integration of wheelchair users in Southwest Colombia. Whirlwind’s local partner is the Corporacion Regional de Rehabilitacion del Valle (CRRV), headquartered in Cali, Colombia. The International Organization for Migration (IOM) is providing technical assistance to USAID in administering this project.

The project has 10 major objectives:

1) Introduce at least two new models of manual wheelchairs that can be adapted to the individual user, are appropriate for their intended use, and can be locally produced and repaired in Colombia;
2) Establish a wheelchair factory and training center in Cali under the auspices of CRRV;
3) Establish an independent wheelchair-testing laboratory at the University del Valle in order to promote voluntary, if not mandatory, adoption of international wheelchair standards by government agencies and NGOs;
4) Design and produce a high quality, low cost wheelchair cushion made from locally available materials;
5) Increase the level of knowledge and the capacity of rehabilitation professionals to prescribe and fit wheelchairs and cushions appropriate to each user;
6) Involve the families of wheelchair users in the users' process of functional, social, and economic integration;
7) Create an intake and support system beginning with our project’s first contact with a person requiring a wheelchair through that person’s reintegration into school, work, and family life;
8) Empower the disabled community to work in its own self-interest by promoting an organization/coalition of wheelchair users through which much of the project’s training and advocacy activities will be carried out;
9) Reform Colombia Law 100 (1993) to include wheelchairs as an item to be paid for by the state-sponsored health insurance program; and
10) Implement a model project for an accessible school.

B. Background
The Department of Valle del Cauca has 4,344,000 inhabitants. Nearly half of the department’s population resides in Cali, the capital. Industry is concentrated primarily in Cali and in the city of Yumbo. There are 42 municipalities in the department. The department also has a port city on the Pacific Ocean, Buenaventura, which has become the destination for many of those fleeing violence in the countryside, including people with disabilities.

Because of its industrial base, the department attracts people from all over the country, and consequently the department lacks a specific sub-cultural identity. In addition to legitimate commerce and industry, the region’s economy was artificially inflated by the infusion of cash from the cocaine trade. But over the last 5 years, the economy has suffered as the government cracked down on drug trafficking and seized assets purchased with drug money, including legitimate businesses, with the resulting increase in unemployment and poverty.

Also, over the last two years, the department has been affected by the influx of refugees from the zones of armed conflict, which daily adds to the number of people with serious mobility impairments and other disabilities. The most serious of these are paraplegia, quadriplegia, and amputations, many of which are the result of the more than 100,000 anti-personnel mines in Colombia, including in 3 of the 42 municipalities in the Valle del Cauca region. Urban gang violence is also a major contributing factor to the rising incidence of disability. In the Valle del Cauca, there are 2 to 3 new cases of spinal cord injury per week from violence and another 8 per day from brain injury caused by violence.

Up to now, Colombia has not provided the necessary support through government-run programs; however; there is some official support for private sector initiatives. The result is that those with health insurance, about 60% of the total population, can receive private sector care. Unfortunately, government-paid health insurance covers only work-related injuries, and almost all of the internal refugees from the countryside and the majority of the victims of urban gang violence lack health insurance entirely.

There is a fairly well developed network of organizations providing services to people with disabilities in the Valle del Cauca. The network has three levels. The first level comprises direct service providers. CRRV, which is WWI’s primary partner for this project, is a second-level organization, overseeing and coordinating the activities of the first-level organizations and providing some direct services itself. CRRV works with 35 first-level organizations in 9 municipalities. CRRV’s work includes negotiating with municipalities to set up legally mandated programs for people with disabilities. CRRV is also part of the third level, which participates in formulating policy on a national scale.

In the Departamento del Valle del Cauca there are four producers of wheelchairs. Two are legitimate businesses, while the other two are "piratas" in the shadow economy who make and sell only a few wheelchairs per month. One of the legitimate shops, Habilitec, produces 70 to 90 wheelchairs per month. Most are hospital style for indoor use and are of mediocre quality. The second legitimate shop is Cromados Vulcano, owned by Guillermo Klusmann, which produces about 30 high quality wheelchairs per month in the $300 to $400 price range. Single-shift capacity at Cromados Vulcano is 100 wheelchairs per month.

Colombia has a number of laws that can serve as the basis for improving opportunities for people with disabilities. These include Law 100 (1993), which lists services and equipment eligible for payment by the government, Law 715 (2002), which looks to integration as the model for schooling rather than special schools for disabled children, Law 361 (1997), which provides for tax incentives to employers for hiring people with disabilities, and the International Convention on the Rights of People with Disabilities, which Colombia signed in 2001.

C. Identification of Specific Problems to be Addressed

The project addresses three major problems facing people in Southwest Colombia who need wheelchairs: 1) the lack of good quality, low cost wheelchairs and wheelchair cushions; 2) the lack of government and private charitable funds for wheelchair purchases; and 3) the need for an effective post-injury support system that will lead to reintegration of new wheelchair users into society.

According to the first census of disabled people completed in 2000, in the city of Cali alone there are 2,563 persons (28% of all persons with disabilities) who need wheelchairs. This number does not count those who have a bad wheelchair or any people who have been disabled since the census was taken in 2000. Decent quality wheelchairs produced in the region cost more than $350. The least expensive chairs in the $120 to $190 range are basic hospital chairs that are either of poor quality or are unsuitable for outdoor use. Many in Cali, especially refugees from the countryside and poor people, who are the most likely victims of the rampant urban violence--do not have social security/medical insurance. Additionally, this group tends to be relatively uneducated and cannot read prescriptions or understand doctor’s instructions when they are discharged from the hospitals. CRRV estimates that more than half get lost in the system, including many who do have medical insurance. Those who cannot afford to pay for private rehabilitation services are sent home to fend for themselves. Newly disabled wheelchair riders do not receive appropriate follow-up once they are discharged from the hospital, and many of them also are sent home to fend for themselves. The poor and uneducated often do not get a wheelchair or receive necessary related services. Medical professionals are not trained how to prescribe (fit) a wheelchair, nor do PTs and OTs receive training in fitting and prescribing wheelchairs for persons with various disabilities. The overall lack of follow-up extends to schooling, job training, and job placement.

Although Law 100, passed in 1993, requires the government to pay for prosthetics and orthotics for those who qualify for state medical insurance, it specifically excludes wheelchairs. Thus, even people who have state medical insurance as an employment benefit must pay for their own wheelchairs. Other legislation intended to protect the rights of people with disabilities is not often enforced.

Finally, wheelchair quality is not regulated in Colombia. ICONTEC, the Colombian Institute of Technical Standards and Certification, a private non-profit organization, has issued wheelchair standards, approved by the Colombian government in 1997, only for determining the overall dimensions, mass, and turning space in accordance with ISO Standard 7176-5 (1986). As a result, those who seek a good quality wheelchair must pay a lot of money, and the majority of wheelchairs produced in Cali are of poor quality. Wheelchair cushions are generally made from egg-crate foam that does not stand up to long-term use and may even cause further injury.

D. Proposed Interventions/Technical Approach and Expected Impact

Wheelchair Technology and Production - The project attacks the problem of high cost, low quality wheelchairs through better designs and the promotion of wheelchair standards.

The project will be part of a larger WWI initiative known as the Whirlwind Industrialization Project (WIP). WIP is a consortium that currently includes WWI and the Arthur B. Schultz Foundation (ABS) of the U.S., the HandiNor wheelchair company in Oslo, and the Atlas Alliance of Norway. WIP’s methodology is to refine and modify WWI wheelchair designs that are based on WWI's more than 25 years of work in developing countries, and make them more suitable for production levels of as many as 300 wheelchairs per month per factory in developing countries. WIP’s worldwide goal is a collective production volume of 20,000 wheelchairs per year.

In this project, WWI will adapt designs of at least two wheelchairs suitable for use by a large number of people, but which can be adjusted for a specific user. These chairs should be able to sell at a profit for as little as $150, although for planning purposes we are using a $200-per chair figure. These designs will be modified in cooperation with HandiNor to make them more suitable for serial production. HandiNor will provide sample wheelchair kits and will also design and produce high quality jigs and fixtures that the project will supply to the Corporacion de Rehabilitacion (CRRV) for its production and training shops. Qualified graduates of the training program, to be overseen by WWI in cooperation with local wheelchair manufacturer Guillermo Klusmann, will be eligible for hire in Klusmann’s company, Cromados Vulcano, and in the production unit that CRRV will set up, as well as, by law, in other local businesses.

Wheelchair Testing - The project will address the problem of poor wheelchair quality by setting up a wheelchair testing laboratory in the industrial design department at the University del Valle (UV). WWI will modify the series of dynamic and static wheelchair strength standards it currently has on its Website (http://whirlwind.sfsu.edu/2020/wtests.html) and design low-cost test equipment that will accurately test different wheelchairs. The new equipment will be installed in the laboratory at UV and WWI will train local staff to operate it. Every wheelchair model available in Cali, both locally made and imported, will be carefully tested and the information accurately recorded. Tests will be filmed with digital video for use by CRRV and the project’s Independent Living Committee to educate wheelchair users about wheelchair quality, to organize them to convince the NGO funders to purchase only wheelchairs that meet the standards, and to advocate for government adoption of wheelchair standards.

The standards we propose, which we call Extended ISO (EISO) standards, are more stringent than ISO standards, which were not designed to test to the standards necessary for wheelchairs that will be subjected to the rough conditions prevalent in developing countries. The EISO standards will be appropriate for wheelchairs that will be actively used outdoors in the rougher conditions that are typical of Colombia. At the same time, however, the project will seek government adoption of ISO standards for wheelchairs that are meant for indoor use. An in-depth survey will be designed and distributed to all persons receiving wheelchairs, and each person as well as each chair will be tracked for the duration of the project to help evaluate wheelchair quality and to determine which factors have the greatest beneficial effect on the economic and social integration of wheelchair users.

Wheelchair Cushions - The final intervention directly related to technology will be the design of a high quality, low cost cushion that, when properly fitted and used, will prevent pressure sores. There are a variety of foam products and cover materials available in Cali that make it feasible to produce a good cushion from aggregate and other types of foam. Independent wheelchair cushion and seating specialist, Jamie Noon, will develop this portion of the project, in coordination with WWI. Noon will also train CRRV personnel to produce this cushion.

Wheelchair Marketing – Initially, the primary wheelchair distributor for the project will be the Nuevo Horizontes Sports Club of people with disabilities. Nuevo Horizontes members have already built some of their own sports chairs, have an active club with their own offices, and run a fitness center as an income-generating activity. Nuevo Horizontes will be an authorized distributor of the new wheelchairs. They will be trained to measure and fit people for wheelchairs, to take orders, to deliver and customize wheelchairs, and to repair them. Nuevo Horizontes members will work closely with members of the Independent Living Committee to promote the project’s objectives.

We will also support a second distributorship/repair shop in the Pacific Coast port city of Buenaventura. Buenaventura is the port through which most of the internal refugees fleeing the war in the Colombian countryside arrive. It has a large disabled population.

In order to provide a sustainable market and to make chairs more affordable for the consumer, we are partnering with ColRotary, an umbrella organization that represents all of the Rotary clubs in the Valle del Cauca, and with the Arthur B. Schultz Foundation (ABS). ColRotary and ABS will raise funds for wheelchair purchases. It will be the project’s policy that each person who receives a wheelchair will have to pay something for that wheelchair since universal experience reveals that less value is placed by recipients on giveaways and that they are viewed by many adults as personally demeaning. As part of each wheelchair user’s evaluation, a social worker will determine how much the person can pay. In order to encourage independence and pride of wheelchair ownership, when a funder intends for wheelchairs to be free, the wheelchair user will be expected to pay the cost of the evaluation, fitting, or associated transportation.

The project’s Independent Living Committee, a semi-autonomous body comprising wheelchair riders and other people with disabilities, will have primary responsibility along with CRRV for carrying out a campaign to amend Law 100 to provide for government purchases of wheelchairs. ILC’s members will be drawn from the various municipal associations of disabled persons as well as from parents of disabled children. Within the last 2 years, CRRV helped organize municipal associations of people with disabilities in 6 different cities.

Focus on the Wheelchair User - The project begins with the person at the point that he or she needs a wheelchair. (We recommend you view the Project Flow Chart as you read this section.)

Interdisciplinary Evaluation Team - Through the project, a caseworker will be assigned to shepherd each person through a careful process leading to successful reintegration. Once ready for discharge from the medical facility, the disabled person will be evaluated by an interdisciplinary team, to include a medical doctor, physical therapist, occupational therapist, psychologist, social worker, and peer counselors. This evaluation will yield a series of recommendations for that person’s physical, social, and economic rehabilitation.

Recommendations will include:

1) Prescribing a wheelchair that will fit the person and be most appropriate for that person’s needs;
2) Providing accurate measurements for a good cushion;
3) Ascertaining how much the person can afford to pay for a wheelchair and other options for paying for a wheelchair; and
4) Employment, job training, and educational options. CRRV will have primary responsibility for putting this team together.
The Independent Living Committee - People with disabilities, especially other wheelchair riders organized by the project’s Independent Living Committee (ILC), will play a major role in providing training and assistance. CRRV and WWI and its subcontractors will provide initial trainings-of-trainers to ILC members. ILC members will then set up teams to train wheelchair riders in wheelchair use and maintenance and in personal care, with an emphasis on treating and preventing the most common problems of those with spinal cord injury, pressure sores and bladder infections. They will also provide peer counseling services and training in sexuality and disability, parenting with a disability, and in the reproductive health issues of women with disabilities. ILC will oversee a mobile unit that will provide in-home support services along a community-based rehabilitation model. These services will include physical access and integration into the family socio-economic unit. The effectiveness of this work will be heightened because wheelchair riders will play the leading role.

The Independent Living Committee will also play a leading role in training the various professionals. WWI’s experience is that wheelchair riders know best what kind of wheelchairs are appropriate to their specific needs and abilities. Together with CRRV, members of ILC will provide training to doctors, physical therapists, and occupational therapists in how to measure, fit, and prescribe an appropriate wheelchair and cushion.

WWI and CRRV will provide organizational capacity-building trainings to ILC activists in such areas as grant writing, program management, fiscal accountability, strategic planning, membership development, fund raising, and media relations so that the existing associations of disabled persons can be strengthened and/or ILC can become a registered NGO, if it chooses, at the project’s conclusion. The CRRV and WWI project directors both have extensive experience in this area. From 1993 to 1995, Krizack assisted a disabled sports club in Novosibirsk to transform itself into an independent living center, that is, a service and advocacy organization run by and for people with disabilities. The organization continues to thrive.

Educational Opportunity - The wheelchair user will receive support to enter school, get vocational training, or find a job. Because there are no elementary or secondary schools in the region that are fully wheelchair accessible, CRRV and ILC will be responsible for identifying at least one such school to be made accessible as a pilot project. Law 715, which established a preference for integrated education, will be the legal basis for this project. In the interim, clients of the program will be able to attend the "Central Didactica," which is a wheelchair-accessible school annex used for educational activities.

Job Training and Employment - If the wheelchair user needs job training, CRRV and ILC will be responsible for placing him or her in an existing job-training program or in the project’s wheelchair-building program. CRRV will offer an employment service to link up wheelchair riders with employers looking to comply with the recently enacted Law 361, which requires businesses to pay for job training for one disabled person for each 12 employees. Under the law, the employer must train the disabled person for one year, at the employer’s expense. The employer then can hire the disabled person for an additional year at 75% of the position’s normal salary. In return, the employer receives a 2% tax credit. Employers must pay a fine for not training/employing at least one disabled person for each12 employees.

If the wheelchair user will be entering a dependent employment situation, that is, as an employee of a mid-size to large firm, CRRV and ILC will also provide an advisory service for the employer to help make workplace accommodations. The project will make special efforts to see that disabled persons trained under Law 361 remain at their places of employment following the two-year apprenticeship period.

If the wheelchair user is to enter into independent self-employment, such as selling foodstuffs, CRRV and ILC will assist the person to get small (microenterprise) loans through existing organizations.

Expected Impact - Each of the above-named activities is deemed an essential part of a comprehensive program to remove the many barriers that limit the integration of wheelchair users into society. The impact of this project will be immense. At the project’s conclusion, we will have put in place or expanded and improved upon a great many of the building blocks of an integral rehabilitation program on which future successes can be built. The model we propose will be readily adaptable, not only for other regions of Colombia, but also for many places throughout the less-developed world.

As long as there is an available market, production can be ramped up to as many as 300 wheelchairs per factory, based on the model being developed through the WIP project in conjunction with the Norwegian wheelchair factory, HandiNor. The purchase price and maintenance costs of owning a wheelchair will go down. Most important, the disabled community of Valle del Cauca will be energized, better organized, and capable of continuing the service and advocacy activities undertaken through our project.

Successful result indicators include:

-Number of wheelchairs produced (and sold). Our specific goals include:
By 12 months: 50 wheelchairs per month
By 24 months: 100 wheelchairs per month
By 30 months: 150 wheelchairs per month
-Design of a better quality cushion;
-Number of new cushions produced (and sold);
-Reduction in the incidence of pressure sores and bladder infections;
-Establishment of a permanent wheelchair standards laboratory in the industrial design department at the University Del Valle;
-Issuance of proposed national wheelchair standards;
-Agreement of NGOs and private charitable organizations to purchase only wheelchairs that meet proposed standards;
-Government adoption of wheelchair standards

The project’s success will also be measured by the number of people actually served by the project beyond receiving a good wheelchair and cushion. These include:

-Number of wheelchair users and their families who receive services through our program: 80 per month
-Number of wheelchair users integrated into the educational system: 30 per year
-Numbers of wheelchair users performing productive work either as employees integrated into the work force or self-employed: 20 per year
The project will support and work together with a series of NGOs and grassroots groups of people with disabilities and their families who will adopt the project as their own, facilitating the organization and implementation of the project’s activities. The project’s impact will also be measured by the
-Number of Independent Living Committees: 4 in the Departamento del Valle during the project.
-Number of Associations of Parents of Disabled Children supported by the project: 4 in the Departamento del Valle.
-Development of a full-fledged wheelchair sales and repair business at Nuevo Horizonte Sports Club.

The project will have the greatest chance for sustainability by building on the fairly well developed rehabilitation infrastructure in the Valle del Cauca region. The project will not duplicate existing structures, but will help wheelchair riders take advantage of opportunities and institutions as much as possible. By choosing the partnership model, we believe that we will engage the energies of the partners more fully than a simple contractual relationship would do. We should also be able to leverage additional financial resources from the partners, as the project evolves, for the implementation of activities the partners mutually agree to carry out, whether they are directly a part of this project or address needs not addressed or not yet identified. The partnership model will also create strong personal bonds that should lead to a relationship between WWI and CRRV that will continue long into the future.

The organization of wheelchair riders, in collaboration with the CRRV, will be the project’s driving force, and at project’s end there will be a cadre of experienced and professionally functioning wheelchair users who will continue to provide services and to advocate in the interests of the disabled community. Tax incentives under Law 361 (2003) for training people with disabilities will continue to provide job training and placement opportunities and will also benefit factories producing our wheelchairs. Although the project focuses on civilian victims of war, the Colombian government can be counted on to purchase wheelchairs for military personnel disabled in the line of duty.

The Whirlwind Industrialization Project also expects to raise significant funds internationally so that once wheelchair production has been established, WIP can donate funds for the purchase of enough wheelchairs to at least sustain core shop operations. Local Rotary clubs have also agreed to support wheelchair purchases and are especially interested in supporting job training and job creation programs.

Finally, because Cali’s recently elected Mayor, who is blind, has been a longtime ally and friend of the director of CRRV, we can expect full support from the city at least for the duration of his term in office, which will end in 2007 (after this project ends). The Mayor’s reelection would ensure an additional 4 years of strong municipal support for the project.

To read more about the Leahy War Victims Fund, go to:
http://www.usaid.gov/our_work/humanitarian_assistance/the_funds/lwvf/